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Groundhog day for our failing health system


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Here’s a news item – “a new hospital waiting list initiative has been launched aimed at clearing long waiters. At present, five hospitals account for over 60% of those on inpatient hospital waiting lists for more than a year. Latest  figures show that just over 18,500 patients are waiting over three months for hospital treatment, while just over 8,600 are waiting over six months.”

Here’s another new item – “a new hospital waiting list initiative has been launched aimed at clearing long waiters. At present, five hospitals account for 70% of people waiting more than a year for treatment. Latest figures show that just under 24,000 are waiting more than three months for treatment, while just over 11,300 are waiting longer than six months for treatment. The numbers waiting over six months have nearly doubled over the past four months.”

The first news item is from January 2010, during the tenure of that much berated former Health Minister, Mary Harney. The second news item is from this week, during the tenure of the current Health Minister James Reilly, who we are told (frequently) is tackling the waiting list problem.

Well, if frequently launching waiting list initiatives and issuing upbeat statements constitutes tackling the problem, one can suppose that Minister Reilly is tackling the problem.

Unfortunately, statistics tend to be brutally frank, and the latest waiting list figures would beg the question as to whether anything has really changed since Mary Harney departed Hawkins House in early 2011.

Admittedly, the numbers on waiting lists increased substantially during Ms Harney’s tenure after January 2010, and by the time James Reilly came to office in March 2011, three month plus waiters stood at 26,000. After a short period of decline,the numbers are now almost reaching those not so dazzling heights yet again.

The Minister has just announced he has launched yet another initiative aimed at clearing the long waiters from the five hospitals responsible for the longest lists

Ministerial initiatives to tackle waiting list backlogs have been part and parcel of the health planning landscape since before Mary Harney’s time as Minister.

Unfortunately, to date they have been no more than more than sticking plaster solutions that so far have failed to tackle the resourcing and organisational problems that have bedevilled proper access to public hospital care for decades, and which have worsened as a result of the economic collapse of recent years.

To be fair to James Reilly, his establishment of a Special Delivery Unit to cut waiting lists and improve access to hospital care has had some success. During 2012, the SDU’s intervention did lead to some improvements in treatment waiting lists, particularly for long waiters.

By the end of 2012, the total number of three month plus waiters had reduced to 18,773, and among these, only 143 patients were waiting over nine months for treatment. The latter figure is now 3,715. The average waiting time for treatment is now three months, compared to 2.5 months last December.

History is repeating itself. Before they started to get out of control, in late 2009, Mary Harney, through the National Treatment Purchase Fund, had got waiting lists down to roughly the levels James Reilly achieved by late last year, before they inevitably rose again.

This waiting list roller coaster of recent years has a common theme running through it- diminishing healthcare resources and in particular, inadequate hospital and community resources to deal with pressure points in the system.

Can any Minister really keep a permanent lid on waiting lists in a health system that has had more than one fifth of its funding removed since 2008, and with more cuts to come in 2014 and in 2015?

Yes, James Reilly can argue that he  has had some success with waiting lists and he will deal with the latest ‘slippage’ through a €18 million funding injection (which will probably get swallowed up pretty quickly).

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But to date it appears that his actions have essentially been ‘fire brigade’ exercises that have yet to deal with systemic flaws in the system.

He says the recent waiting list rise was due to a longer ‘clinical winter’ and a higher than normal level of elderly emergency admissions. But if the system is being changed for the better, as we are told, shouldn’t it be able to cope with these surges?

If waiting lists are really being tackled, shouldn’t we be seeing a more or less permanent decline in numbers, and not have to be frequently going back to the waiting list drawing board simply because very ill emergency patients are turning up in hospitals and needing beds?

It is alarming to note that the Minister admitted this week that the recent pressure on beds caused by higher than usual admissions through EDs had to be be dealt with through reducing the number of planned procedures, thereby increasing waiting list numbers, which then have to be dealt with by yet another special initiative.

And the Minister certainly likes his initiatives.

James Reilly’s SDU has launched many of these with varying degrees of success. We have had the patchily successful treatment waiting list initiative referred to above.

We have had an ED trolley wait initiative, which has has reduced trolley numbers, although the figure are still quite high.

Also, figures from the Irish Nurses and Midwives Organisation indicate that recently, the old trolley problem has simply turned into an overcrowded ward problem.

We have had two initiatives under James Reilly to reduce waiting times for colonoscopy and gastroscopy tests. Numbers waiting for these tests, often used to check for cancer, are on the rise again.

We have had a more recent initiative from the SDU to reduce outpatient waiting lists. With nearly 7,000 waiting over four years for a first outpatient appointment and 380,000 in total on these lists at the latest count, this particular initiative clearly has a long way to go.

And then we have the ‘hidden’ waiting lists that don’t normally get officially reported.

A recent Irish College of General Practitioners survey of 300 GPs showed that their private patients only had to wait an average of four days when they were referred to a private hospital for for an ultrasound test, whereas their public patients had to wait on average 14 weeks for this test at a public hospital.

The average wait for an MRI scan for a GP‘s public patient was 22 weeks – nearly six months. Private patients could get these scans done within seven days, the survey showed.

If the GP college didn’t tell us this then we would never have heard about these shocking waiting lists. Up to date figures on average waiting times for GP referrals for hospital diagnostic tests are not published by the HSE or the Department of Health.

Another hidden waiting list is where even if patients get into the hospital system, they still have to wait. Diabetes patients in some hospitals sometimes have to wait two to three years for an outpatient check up, where they are already in the hospital system and have already seen a consultant for the first time.

Again, these statistics are not revealed publicly by the HSE or Department of Health.

James Reilly cannot be faulted for making an effort to improve public patient access to our health system.

Yet, through all the swings and roundabouts of fluctuating waiting list and trolley numbers, and the often reported hardship suffered by sick patients through poor access and poor facilities, and Ministerial promises that things are getting better, the underlying message seems to be that our health system still doesn’t work, despite all the ‘spin’.

The bottom line seems to be that despite some pockets of efficiency and indeed excellence in the service, our broke statelet simply does not have the resources at the moment to provide a uniform standard of quality care.

The hidden truth is that all that can be hoped for is to keep the current system ticking over and hope that not too many people come to too much harm.

Resources are often promised, but seldom delivered, to improve hospital services at crucial pressure points, or to fund community and primary care to a proper level take pressure off hospitals and keep patients out of hospital.

Until this key issue can be resolved, everything else we are told or retold by Minister Reilly and his junior ministers is essentially window dressing.

And as for universal healthcare by 2016 (to be run by insurance companies no less), dream on.

88% rise in treatment waiting lists

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via Groundhog day for our failing health system – irishhealth.com.

Brain Study Shows Link Between Fructose and Overeating


A new study adds evidence that fructose (and its relative, high fructose corn syrup) may play a role in obesity, according to the Associated Press. MRI scans showed that fructose can trigger brain changes that may lead to overeating.

The results add fire to the ongoing debate of whether or not all sugars are created equal.

From the AP:

Scans showed that drinking glucose “turns off or suppresses the activity of areas of the brain that are critical for reward and desire for food,” said one study leader, Yale University endocrinologist Dr. Robert Sherwin. With fructose, “we don’t see those changes,” he said. “As a result, the desire to eat continues — it isn’t turned off.”

This isn’t the only study that makes fructose a bad actor compared to glucose. GAP client and whistleblower Renee Dufault gave a presentation a couple weeks ago at our office in Washington D.C. on the impact of high fructose corn syrup (HFCS) and human metabolism.

“The more fructose we eat, the faster we gain weight,” Dufault stated. She explained that people can become obese eating too much cane sugar as well as eating too much high fructose corn syrup, but that it will happen faster via HFCS consumption because it has more fructose. Check back on the FIC blog for video of her presentation!

via Brain Study Shows Link Between Fructose and Overeating – Food Integrity Campaign.

via Brain Study Shows Link Between Fructose and Overeating – Food Integrity Campaign.

Focal therapy offers middle ground for some prostate cancer patients


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Men with low-risk prostate cancer who previously had to choose between aggressive treatment, with the potential for significant side effects, and active surveillance, with the risk of disease progression, may have a new option. Focal laser ablation uses precisely targeted heat, delivered through a small insertion and guided into the prostate by magnetic resonance imaging, to burn away cancerous cells in the prostate.

A small, phase 1 trial, to published early online in the journal Radiology, found that this approach, designed to treat just the diseased portion of the prostate rather than removing or irradiating the entire gland, is safe and can be performed without the troubling complications associated with more aggressive therapies.

None of the nine men treated in the study had a significant side effect. Six months after therapy, seven of the nine patients (78%) no longer had evidence of cancerous tissue in biopsies of the treated area.

“Focal therapy is the male version of a lumpectomy for breast cancer,” said study author Scott Eggener, MD, associate professor of surgery at the University of Chicago Medicine. “Rather than removing the entire organ, we are testing this less-invasive way of destroying just the cancer and leaving healthy tissue in place.”

“This experimental approach appears to combine the most attractive element of treatment, eradication of the cancer, with the most appealing element of active surveillance, maintaining quality of life,” said Aytekin Oto, MD, professor of radiology and chief of abdominal imaging at the University of Chicago Medicine. “These early safety results are promising, but we definitely need longer-term data.”

More than 2 million American men have been diagnosed with prostate cancer. Due to prostate specific antigen testing (PSA), most of these cancers are detected early, long before they cause symptoms. Because this cancer occurs primarily in older men, treatment with radiation or surgery is not always necessary as these are man are much more likely to die from another cause than from prostate cancer.

But many healthy men who are relatively young, with a life expectancy greater than 10 years, are not comfortable deferring treatment of a potentially lethal disease. Surgery and radiation can often cure the cancer, but can cause side effects, such as incontinence, impotence and decreased bowel function.

This study enrolled nine men with biopsy-confirmed, low-risk prostate cancers (Gleason score 6 or 7, less than 12 mm of cancer) with an MRI of the prostate showing a small area of cancer. Patients were treated under conscious sedation while lying in an MRI scanner. After injecting a local anesthetic, the physicians inserted a small catheter across the perineum and used it to guide a tiny optical fiber, the laser and a cooling device into the prostate.

Under MRI guidance, the laser was positioned within the cancer and used to heat the area to a temperature that would kill cancer cells. The team checked the temperatures outside the treatment region every five seconds to protect healthy tissue, especially those near critical structures such as the urethra and rectal wall.

The entire procedure took less than four hours. That decreased to 2.5 hours as the team gained experience. The actual heat treatment averaged 4.3 minutes. All patients left the hospital the same day.

No patient had a major complication or a serious adverse effect. Average scores for urinary or sexual function were not significantly different one, three or six months after treatment. No patient had symptoms of rectal wall damage.

Biopsies of the treated areas six months after the procedure found no evidence of prostate cancer in seven of the nine patients (78%). The other two patients had small (2.5 mm and 1 mm) remaining cancers.

These are preliminary results, the authors caution, following a small number of patients for a short time. It will take much longer follow-up, the authors say, to fully evaluate this approach.

Focal laser ablation is the lastest in a series of efforts to target just the cancer cells and preserve normal areas of prostate. It appears to offer “measurable advantages over other ablative therapies for focal prostate treatment, namely that we can visualize our treatment as it is happening,” according to the study authors.

Laser-induced heating can destroy cancer cells with little damage beyond the precisely targeted zone. The approach is well suited for prostate tissue and can be carefully watched in real-time with magnetic resonance imaging, which can also monitor the generation and consequences of the heat treatment.

A phase 2 trial of this procedure, sponsored by the National Institutes of Health, is now underway at the University of Chicago Medicine. The physicians hope to enroll 27 patients. Details are available at the NIH’s ClinicalTrials.gov website, identifier: NCT01792024.

via Focal therapy offers middle ground for some prostate cancer patients.

via Focal therapy offers middle ground for some prostate cancer patients.

Poor sleep in old age prevents the brain from storing memories


The connection between poor sleep, memory loss and brain deterioration as we grow older has been elusive. But for the first time, scientists at the University of California, Berkeley, have found a link between these hallmark maladies of old age. Their discovery opens the door to boosting the quality of sleep in elderly people to improve memory.

Postdoctoral fellow, Bryce Mander, demonstrates how the sleep study was conducted.

UC Berkeley neuroscientists have found that the slow brain waves generated during the deep, restorative sleep we typically experience in youth play a key role in transporting memories from the hippocampus — which provides short-term storage for memories — to the prefrontal cortex’s longer term “hard drive.”

However, in older adults, memories may be getting stuck in the hippocampus due to the poor quality of deep ‘slow wave’ sleep, and are then overwritten by new memories, the findings suggest.

“What we have discovered is a dysfunctional pathway that helps explain the relationship between brain deterioration, sleep disruption and memory loss as we get older — and with that, a potentially new treatment avenue,” said UC Berkeley sleep researcher Matthew Walker, an associate professor of psychology and neuroscience at UC Berkeley and senior author of the study to be published Jan. 27, in the journal Nature Neuroscience.

The findings shed new light on some of the forgetfulness common to the elderly that includes difficulty remembering people’s names.

“When we are young, we have deep sleep that helps the brain store and retain new facts and information,” Walker said. “But as we get older, the quality of our sleep deteriorates and prevents those memories from being saved by the brain at night.”

Healthy adults typically spend one-quarter of the night in deep, non-rapid-eye-movement (REM) sleep. Slow waves are generated by the brain’s middle frontal lobe. Deterioration of this frontal region of the brain in elderly people is linked to their failure to generate deep sleep, the study found.

The discovery that slow waves in the frontal brain help strengthen memories paves the way for therapeutic treatments for memory loss in the elderly, such as transcranial direct current stimulation or pharmaceutical remedies. For example, in an earlier study, neuroscientists in Germany successfully used electrical stimulation of the brain in young adults to enhance deep sleep and doubled their overnight memory.

UC Berkeley researchers will be conducting a similar sleep-enhancing study in older adults to see if it will improve their overnight memory. “Can you jumpstart slow wave sleep and help people remember their lives and memories better? It’s an exciting possibility,” said Bryce Mander, a postdoctoral fellow in psychology at UC Berkeley and lead author of this latest study.

For the UC Berkeley study, Mander and fellow researchers tested the memory of 18 healthy young adults (mostly in their 20s) and 15 healthy older adults (mostly in their 70s) after a full night’s sleep. Before going to bed, participants learned and were tested on 120 word sets that taxed their memories.

As they slept, an electroencephalographic (EEG) machine measured their brain wave activity. The next morning, they were tested again on the word pairs, but this time while undergoing functional and structural Magnetic Resonance Imaging (fMRI) scans.

In older adults, the results showed a clear link between the degree of brain deterioration in the middle frontal lobe and the severity of impaired “slow wave activity” during sleep. On average, the quality of their deep sleep was 75 percent lower than that of the younger participants, and their memory of the word pairs the next day was 55 percent worse.

Meanwhile, in younger adults, brain scans showed that deep sleep had efficiently helped to shift their memories from the short-term storage of the hippocampus to the long-term storage of the prefrontal cortex.

Co-authors of the study are William Jagust, Vikram Rao, Jared Saletin and John Lindquist of UC Berkeley; Brandon Lu of the California Pacific Medical Center and Sonia Ancoli-Israel of UC San Diego.

The research was funded by the National Institute of Aging of the National Institutes of Health.

via Poor sleep in old age prevents the brain from storing memories.

via Poor sleep in old age prevents the brain from storing memories.

Fructose ‘may spur overeating’


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Scientists have used imaging tests to show for the first time that fructose, a sugar that saturates the American diet, can trigger brain changes that may lead to overeating.

After drinking a fructose beverage, the brain does not register the feeling of being full as it does when simple glucose is consumed, researchers found.

The small study does not prove that fructose or its relative, high-fructose corn syrup, can cause obesity, but experts say it adds evidence that they may play a role.

These sugars are often added to processed foods and beverages and consumption has risen dramatically since the 1970s along with obesity. A third of US children and teens and more than two-thirds of adults are obese or overweight.

All sugars are not equal – even though they contain the same amount of calories – because they are metabolised differently in the body. Table sugar is sucrose, which is half fructose, half glucose. High-fructose corn syrup is 55% fructose and 45% glucose. Some nutrition experts say this sweetener may pose special risks, but others and the industry reject that claim. And doctors say we eat too much sugar in all forms.

For the study, scientists used magnetic resonance imaging, or MRI, scans to track blood flow in the brain in 20 young, normal-weight people before and after they had drinks containing glucose or fructose in two sessions several weeks apart.

Scans showed that drinking glucose “turns off or suppresses the activity of areas of the brain that are critical for reward and desire for food”, said one study leader, Yale University endocrinologist Dr Robert Sherwin. With fructose, “we don’t see those changes”, he said. “As a result, the desire to eat continues – it isn’t turned off.”

What is convincing, said Dr Jonathan Purnell, an endocrinologist at Oregon Health & Science University, is that the imaging results mirrored how hungry the people said they felt, as well as what earlier studies found in animals.

“It implies that fructose, at least with regards to promoting food intake and weight gain, is a bad actor compared to glucose,” he said. He wrote a commentary that appears with the federally funded study in the Journal of the American Medical Association.

Researchers now are testing obese people to see if they react the same way to fructose and glucose as the normal-weight people in this study did.

via Fructose ‘may spur overeating’ – World News, Breaking News – Independent.ie.

via Fructose ‘may spur overeating’ – World News, Breaking News – Independent.ie.

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